5 Easy Dupuytren’s Contracture Exercises for Finger Pain Relief

• Dupuytren’s contracture is a hand condition that affects the connective tissue in the palm.
• It causes the fingers to curl inward, making it difficult to perform everyday tasks.
• Physical therapy is often recommended to help manage symptoms and improve hand function.
• Dupuytren’s contracture exercises can help increase the hand’s flexibility and range of motion.
• These exercises may include stretching, gripping, and massaging techniques.

If you have developed flexion contracture of one or two fingers with a tight cord on the base of the finger that makes it difficult to straighten it then chances are it is due to a disease known as Dupuytren’s contracture. It is commonly seen in older males suffering from diabetes. Although there is no cure, research proposes a combination of surgical intervention, night splinting, and home Dupuytren’s contracture exercises as a treatment protocol².

This article will discuss Dupuytren’s contracture’s causes and possible risk factors. We will mainly focus on symptoms and post-surgical home exercises.

What’s Dupuytren’s contracture

To understand what is Dupuytren’s contracture is, let us start with a case study.

“A 60-year-old housewife has pain in the right side ring finger and the finger has remained bending for the past week. It’s painful when she tries to straighten it. She described that one week before, she experienced pain in the right ring finger and little finger spontaneously at midnight.

She described that the finger started to bend for itself; it was painful to try to straighten it. The next day, she went to her family physician, who advised her for medication along with some exercises. After one week, she came to physiotherapy for further consultation.”

So, what is Dupuytren’s contracture? Dupuytren’s contracture is a fibroproliferative disorder of palmar fascia that causes flexion contractures of one or more digits ¹. It is the fibrous thickening & shortening of palmar aponeurosis resulting in flexion contracture of one or more fingers. It can affect any finger, but commonly, it affects the little finger and ring finger. It appears in middle-aged and elderly people and affects men more than women. 

The palmar aponeurosis is normally a thin but tough membrane underneath palmar skin. Proximally attached to the flexor retinaculum and distally to the base of the proximal phalanx. In Dupuytren’s contracture, palmar aponeurosis becomes thick and slowly, contracture starts developing, causing the finger to go down into the palm. To start with, nodular swelling develops at the base of the ring finger, gradually bending the finger first in the MCP (Metacarpophalangeal) joint and then the IP (Interphalangeal) joint.

It affects the ring finger & little finger; the cord-like thick structure is visible outside in an established case. In the latter case, there is an adaptive contracture of the capsule.

Clinical feature of Dupuytren’s contracture

As you can see in the figure (Image credit), it starts as a simple nodule in stage 1, which is the Dupuytren’s contracture early signs. It is a painless nodule that often goes unnoticed until it turns to stage 2, where a noticeable fibrous band formation can be seen. If you find such symptoms, you should immediately see doctors who treat Dupuytren’s contracture. As the disease progresses, it reaches stage 3, when a tight cord causes the fingers to bend and cannot straighten.

Once contracture develops, the fingers get in the way affecting simple everyday tasks such as face washing (poking the eye with the affected digit), combing hair, putting the hand in a pocket or glove, driving or playing sports. Dupuytren’s disease often develops in both hands (hand dominance is unrelated). It most commonly affects the ring and little fingers, followed by the index, middle fingers and thumb. Disease severity and impact on life are variable but worse in young individuals with aggressive disease¹.

The cause of Dupuytren’s contracture is unknown & uncertain, but common factors are usually associated with such cases.

1. In some cases, there is familial involvement suggestive of hereditary.
2. Sometimes, it is found to be related to trauma/injury to the tissue palm.
3. Many cases have been found related to epilepsy due to regular intake of the anticonvulsive drug.   

Easy hand exercises for dupuytren’s contracture

Before moving to exercises, I want to mention Dupuytren’s contracture enzyme treatment. It is a non-surgical treatment in which a hand specialist injects a special enzyme treatment directly into the cord, causing limited mobility in the finger. The enzyme releases the cord. Within 24 hours of injection, this tight cord is released under local anaesthesia. 

Physiotherapy intervention should start as soon as the problem is diagnosed. Physical therapy and other conventional treatments will best work on stage 1 and stage 2—the final stage, i.e. stage 3 needs corrective surgery followed by splinting and physiotherapy exercises. We will come to exercises; here’s a brief on what to expect when you visit your physiotherapist.

1. In early-stage DTFM (Deep Transverse Friction Massage) is given.
2. The ultrasonic therapy machine gives ultrasonic therapy to soften the tight structures.
3. Stretching exercises for the shortened structure.

Now, let us jump to the exercises that can help you if you have Dupuytren’s contracture in stages 1 and 2.

#1 Self-massage for Dupuytren’s contracture

For Dupuytren’s contracture, the self-massage technique can be very effective in alleviating the pain. The best part is that you can easily perform this technique at home without special equipment or assistance. To perform this self-massage technique, you will need to use the thumbs of your other hand.

1. Start by palpating the base of the affected finger with your thumb to locate the tender spot.
2. Once you have found it, apply pressure with your thumb and move it circularly to give a comfortable massage.
3. Before starting the massage, you can apply a pain balm over the tender spot for better results. This will help to reduce the pain and make the massage more effective.
4. You should perform this self-massage technique for 5 minutes in a single session twice daily.

#2 Tendon gliding exercises for dupuytren’s contracture

It is essential to keep your hands and fingers healthy. One exercise that can help achieve this is the finger stretch exercise.

1. Start by spreading your fingers as wide as possible, then slowly bend them until your fingertips touch the top of your palm.
2. Hold for a few seconds, then straighten your fingers and repeat the process, bending until your fingertips touch the middle of your palm.
3. Open your fingers wide again, then bring your fingertips to touch the bottom of your palm.
4. Next, bring your thumb to touch each fingertip, starting with your index finger and moving to your little finger.
5. Finally, bring your thumb to touch different places on your palm.
6. This exercise should be done in 3 sets, twice daily, to help improve flexibility and reduce finger tension.

#3 Stretches for Dupuytren’s contracture

The first stretching exercise (first image) is done to increase the extensibility of the contracted flexor retinaculum of any affected fingers. This exercise can be performed on each finger individually or on all affected fingers together. For this exercise

1. To stretch the muscles and tendons in your fingers, start by placing your palm flat on a table or another flat surface.
2. Next, using your other hand’s index finger, gently pick up one of your fingers and extend it away from your palm.
3. Keep extending the finger until you feel a comfortable stretch in the palm of your hand.
4. Hold the stretch for about ten seconds, and then release the finger.
5. Repeat this process with your fingers, stretching each finger only to the point where you feel comfortable and not to the point of pain or discomfort.

For the second stretching exercise,

1. Sit down and stabilize your arm over a table.
2. Using the other hand, place your palm facing upwards over the finger of the affected side.
3. Apply a downward pressure to the affected finger and hold it for 30 seconds.
4. This will provide a nice and comfortable stretch to the flexor muscles and tendons.
5. It is recommended that this exercise be repeated 3 to 4 times in a session to achieve the best results.

#4 Ball squeezing exercise for dupuytren’s natural remedies

The fourth exercise in Dupuytren’s contracture exercises is the ball squeezing exercise. For this exercise, squeeze a gel or sponge ball with your affected hand. This will also help improve blood circulation. Please do it for as many repetitions as possible.

#5 Home remedies for Dupuytren’s contracture

Next, you might want to try the hot treatment. To do this, you will need a bowl of warm water and one tablespoon of edible salt.

1. Start by immersing your affected hand in the water, making sure that the water covers the entire surface of your hand.
2. Now, start making a tight fist and then slowly straighten your fingers.
3. You should repeat this motion several times, taking your time and being gentle with your affected hand.
4. As you continue to do this, you will feel the water’s warmth penetrating your hand, helping to alleviate the stiffness and pain associated with Dupuytren’s contracture.

Once you have completed the exercise, you can remove your hand from the water and let it rest for a few minutes. If you want to try a more advanced version of this treatment, consider a contrast bath, where you alternate between immersing your hand in hot and cold water.

Surgical management

Corrective surgery is the mainstay treatment for Dupuytren’s disease, from which most patients can gain significant functional improvement. However, there are a few non-surgical treatments that include corticosteroid injections to treat painful nodules. The medication is injected directly into the affected area. Two surgical approaches are considered for Dupuytren’s contracture depending upon the condition.

1. Fasciectomy: complete or incomplete removal of the facia (including skin), suggested for extensive fascia involvement or recurrence of contracture.
2. Fasciotomy: simple division of fascia, recommended for the less extensive case.

The satisfactory outcome depends not only on the degree of extension achieved but also on surgical complications and maintenance of some flexion for a functionally useful hand rather than a stiff, straight digit or a vascularly compromised finger requiring amputation.

Post-operative physiotherapy

The most common complication is postoperative joint stiffness and loss of pre-operative flexion. Hand therapy and rehabilitation using thermoplastic night splints and regular physiotherapy exercises may aid in postoperative recovery.

For wrist joint stiffness the recommended exercises are wrist flexion extension, wrist radial ulnar deviation and wrist circumduction.

Concluding statement

In conclusion, performing regular exercises can be helpful in managing the symptoms of Dupuytren’s contracture, and may even help slow down its progression. However, it is important to consult with a healthcare professional before starting any new exercise routine, to ensure that it is safe and appropriate for your individual needs.

Keep Reading: 5 Easy Trigger Finger Exercises & Self-Massage Technique

Sunit. S. Ekka

Dr Sunit Sanjay Ekka is a physiotherapist in practice for the last 15 years. He has done his BPT from one of the premium Central Government physiotherapy colleges, ie, SVNIRTAR. The patient is his best teacher and whatever he gets to learn he loves to share it on his Youtube channel and blog.